Re-evaluating the need for universal iron supplementation in pregnant Indian women in the light of gestational age specific low hemoglobin prevalence

Background: Anemia prevalence among Indian pregnant women in 2015-16 was 50.4% and has not declined from 49.7% in 1998-99 despite the national policies on iron-folic acid supplementation. New gestational age-specific cut-offs (INTERGROWTH cut-off) for risk of low Hemoglobin (Hb) have been identified. Aims and objectives: Compare prevalences of low Hb based on WHO and INTERGROWTH cut-offs Methods: The prevalence of anemia/low Hb among pregnant women in trimesters 2 and 3 from NFHS-4 data were estimated using the current WHO recommendations and the INTERGROWTH cut-offs. Results: Prevalence of low Hb by the INTERGROWTH cut-off was 28.1%(95% CI:26.9-29.4) and 21.7%(95% CI:20.6-22.9) in trimesters 2 and 3. Anemia prevalence by WHO cut-off was much higher at 41.2%(95% CI:39.8-42.5) and 54.8%(95 CI:53.2-56.3) in trimesters 2 and 3. The prevalence of low-Hb was similar between ANC and no-ANC reported groups in both trimesters (26.1% and 28.9% in trimester-2; 20.1% and 22.4% in trimester-3). Conclusion: The prevalence of low-Hb with gestational age specific cut-offs is much lower compared to earlier estimates using WHO cut-off. The universal iron supplementation program for pregnant women in India need to be re-examined in this light and a tragetter Hb testing based supplementation may be more beneficial in reducing anemia prevalence.

Determinants of adherence to iron-folic acid supplementation among postnatal mothers in Addis Ababa referral hospitals, Ethiopia

Abstract: In Ethiopia, adherence to iron-folic acid supplementation is extremely low. There were only 5% who took more than 90 tablets during their pregnancy. However, only limited data is available on the determinant factors of non-adherence. Therefore, the aim of this study was to identify determinants of adherence to iron-folic acid supplementation among postnatal mothers in three referral hospitals of Addis Ababa, Ethiopia.Methods: An institutional based unmatched case-control study was conducted on 240 women who have been at postnatal care. Data were collected using interviewer administered questionnaire. Data were entered and analyzed using EpiData and SPSS version 20.0, respectively. Bivariate and multivariate logistic regressions were employed to identify the determinants at p-value < 0.25 and < 0.05, respectively.Results: The major determinant factors of adherence to iron-folic acid supplementation were, mothers age group 29-33 [AOR=1.66, 95% CI: 2.010-0.0492], ANC initiation time [AOR=4.21, 95% CI: 2.3-10.6], counseling on IFAS [AOR=3.89, 95% CI: 1.8-8.4], time taken to travel to health facility [AOR=3.17,95% CI:1.35-7.4], gravidity [AOR=2.08,95% CI:1.06-4.09], morning sickness [AOR 0.33, 95% CI: 0.15-0.69] and planned pregnancy [AOR=4.2, 95% CI: 1.6-10.9].Conclusion: This study highlighted age of participants, planned pregnancy, antenatal care initiation time, morning sickness, gravidity, counseling and distance to health facility are the key factors that have independently associate with adherence. Counseling should be given for clients on the correct dosage and duration of supplementation to prevent anemia and neural tube defects.

Determinants of adherence to iron-folic acid supplementation among postnatal mothers in Addis Ababa referral hospitals, Ethiopia

Abstract: In Ethiopia, adherence to iron-folic acid supplementation is disappointingly low were only 5% took more than 90 tablets during their pregnancy; however, only limited data are available on the determinant factors of non-adherence. Therefore, the aim of this study was to identify determinants of adherence to iron-folic acid supplementation among postnatal mothers in three referral hospitals of Addis Ababa, Ethiopia.Purpose:Methods: An institutional based unmatched case-control study was conducted on 240 women who have been at postnatal care. Data were collected using interviewer administered questionnaire. Data were entered and analyzed using EpiData and SPSS version 20.0, respectively. Bivariate and multivariate logistic regressions were employed to identify the determinants at p-value < 0.25 and < 0.05 respectively.Results: The major determinant factors of adherence to iron-folic acid supplementation were, mothers age group 29-33 [AOR=1.66, 95% CI: 2.010-0.0492], ANC initiation time [AOR=4.21, 95% CI: 2.3-10.6], counseling on IFAS [AOR=3.89, 95% CI: 1.8-8.4], time taken to travel to health facility [AOR=3.17,95% CI:1.35-7.4], gravidity [AOR=2.08,95%CI:1.06-4.09], morning sickness [AOR 0.33, 95% CI: 0.15-0.69] and planned pregnancy [AOR=4.2, 95%CI: 1.6-10.9].Conclusion: This study highlighted age of participants, planned pregnancy, antenatal care initiation time, morning sickness, gravidity, counseling and distance to health facility are factors that have independently associate with adherence. Counseling should be given for clients on the correct dosage and duration of supplementation for prevention of anemia and neural tube defects.

The acceptability of weekly iron-folic acid supplementation and its influencing factors among adolescent school girls in Yogyakarta city: a mix-methods study

Introduction: Indonesia has initiated the weekly iron-folic acid supplementation programme (WIFS) among adolescent school girls since 2016. However, its acceptability needs to be investigated. This study aimed to assess the acceptability of WIFS and its influencing factors. Methods: A mixed-methods study was conducted in six schools in Yogyakarta from January-April 2018. Totally, 211 participants aged 12-18 years were involved in the cross-sectional survey, followed by four focus group discussions (FGDs) and in-depth interviews (IDIs). Body mass index-for-age, haemoglobin, serum ferritin, habitual intake, and acceptability (defined as selfreported iron-folic acid tablet consumption) were assessed. Results: This study reported that 22.3% and 12.4% of the participants were categorised as iron deficient and anaemic, respectively. Almost 90% of participants had received the tablet, but only 62.0% of them reported consuming it. Logistic regression test indicated that the participants were more likely to take the tablet if it tasted good [OR (95%CI): 4.66 (1.90-11.43)]. Meanwhile, motivation for tablet consumption declined when respondents perceived the odour of tablet was unpleasant, reported forgetfulness, lacked peer support, and experienced side effects, with OR (95%CI) of 0.23 (0.07- 0.77), 0.35 (0.13-0.95), 0.30 (0.08-0.58), and 0.04 (0.04-0.39), respectively. The results from FGD and IDIs strengthened the findings that the experience of nausea, organoleptic properties of iron-folic acid tablet, forgetfulness, and mother’s support play important roles in students’ acceptability. Conclusion: This study found moderate acceptability towards the WIFS programme. The inhibiting and reinforcing factors of WIFS acceptability in this study could be considered as inputs for programme improvements in the future.